Predictors of severity of SARS-CoV-2 infections in Brazil: Post hoc analyses of a randomised controlled trial.

Autor: Conlin K; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK. Electronic address: kerry.conlin@yale.edu., Jenkin D; Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK. Electronic address: daniel.jenkin@ndm.ox.ac.uk., de Whalley P; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK. Electronic address: philip.dewhalley@paediatrics.ox.ac.uk., Weckx LY; Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil. Electronic address: lily.crie@huhsp.org.br., Folegatti PM; Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK. Electronic address: pedro.folegatti@ndm.ox.ac.uk., Bibi S; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK. Electronic address: sagida.bibi@paediatrics.ox.ac.uk., Lambe T; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, UK. Electronic address: teresa.lambe@paediatrics.ox.ac.uk., Aley PK; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK. Electronic address: parvinder.aley@paediatrics.ox.ac.uk., Pollard AJ; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK. Electronic address: andrew.pollard@paediatrics.ox.ac.uk., Voysey M; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK. Electronic address: merryn.voysey@paediatrics.ox.ac.uk., Costa Clemens SA; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Institute of Global Health, University of Siena, Siena, Brazil. Electronic address: sue.costaclemens@paediatrics.ox.ac.uk.
Jazyk: angličtina
Zdroj: Vaccine [Vaccine] 2024 Dec 14; Vol. 45, pp. 126582. Date of Electronic Publication: 2024 Dec 14.
DOI: 10.1016/j.vaccine.2024.126582
Abstrakt: Objectives: To identify demographic, clinical and immunological factors associated with adverse COVID-19 outcomes.
Methods: A large randomised controlled trial of ChAdOx1 nCoV-19 was undertaken in Brazil. Participants were randomised 1:1 either to receive ChAdOx1 nCov-19 or to a control group. COVID-19 infections were confirmed by nucleic acid amplification test (NAAT) and classified using the WHO clinical progression scale. Anti-spike antibody responses and serum neutralising activity were measured 28 days after second vaccination in some participants. Exploratory analyses were conducted into factors associated with COVID-19 infection severity and hospitalisation, using logistic regression models adjusted for demographic and clinical factors.
Results: 10,416 participants were enrolled; 1790 had NAAT-positive COVID-19 infection; 63 cases required hospitalisation. More severe infection was associated with greater body-mass index (BMI) (odds ratio [OR] = 1.06 [95 %CI: 1.01-1.10], p = 0.01) and diabetes (OR = 3.67 [1.59-8.07], p = 0.003). Hospitalisation risk increased with greater age (OR = 1.06 [1.03-1.08], p < 0.001) and BMI (OR = 1.10 [1.05-1.16], p < 0.001). More severe infection and hospitalisation risks increased >180 days after last vaccination. In the fully vaccinated subgroup (n = 841), only greater age predicted hospitalisation (OR = 1.07 [1.03-1.12], p < 0.001). Serological responses to two vaccine doses diminished with age.
Conclusions: Unvaccinated individuals with high BMI and diabetes risked more severe COVID-19 outcomes. Vaccination mitigated this risk.
Clinical Trial Registration Number: NCT04536051.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Financial support for study as a whole, not individual authors,was provided by the Lemann Foundation, AstraZeneca, the Coalition for Epidemic Preparedness Innovations, NIHR Oxford Health Biomedical Research Centre, Rede D’Or, Fundação Brava and Telles Foundation. Pedro Folegatti reports financial support was provided by Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior, Brazil. Andrew J Pollard reports a relationship with UK DHSC Joint Committee on Vaccination & Immunisation that includes: board membership. Andrew J Pollard reports a relationship with Strategic Advisory Group of Experts on Immunization to the WHO that includes: board membership. Teresa Lambe reports a relationship with Vaccitech that includes: consulting or advisory. Pedro Folegatti reports a relationship with Vaccitech that includes: consulting or advisory. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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